Department of Internal Medicine,, Mayo Clinic, Rochester, MN, USA.
Division of Hematology,, Mayo Clinic, Rochester, MN, USA.
Blood Cancer J. 2018 Feb 28;8(3):26. doi: 10.1038/s41408-018-0065-8.
Advances in therapy in recent years have led investigators to challenge the dogma that multiple myeloma (MM) is incurable. We assessed overall (OS) and progression-free survival (PFS) of young patients ( ≤ 50 years) with MM and compared outcomes with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and Hodgkin lymphoma (HL). All patients ≤ 50 years with newly diagnosed MM (n = 212), FL (n = 168), DLBCL (n = 195), and HL (n = 233) between 1 January 2005 and 31 December 2015 were included. Observed vs. expected survival was summarized by standardized mortality ratios (SMR). Compared to the background US population, excess mortality risk was seen at diagnosis in all four cancers, SMR 19.5 (15.2-24.5) in MM, 4.2 (2.3-7.2) in FL, 13.0 (9.2-18.4) in DLBCL, and 5.2 (2.6-9.3) in HL. We reasoned that cure would most likely occur in the first 3 years after diagnosis and be reflected by an overall survival probability similar to the background population. From the 36-month landmark, excess mortality risk was seen in MM (SMR 20.7 [14.7-28.3]) and FL (SMR 3.8 [1.5-7.8]), but not with DLBCL (SMR 3.1 [0.8-8.0]) or HL (SMR 0.9 [0.0-5.1]). MM patients have 20-fold excess mortality risk compared to the background population at diagnosis and at 3 years after diagnosis, suggesting that MM remains an incurable cancer.
近年来，治疗方法的进步促使研究人员对多发性骨髓瘤（MM）无法治愈的定论提出了挑战。我们评估了年轻患者（≤50 岁）的总体生存（OS）和无进展生存（PFS），并将结果与滤泡性淋巴瘤（FL）、弥漫性大 B 细胞淋巴瘤（DLBCL）和霍奇金淋巴瘤（HL）进行了比较。所有 2005 年 1 月 1 日至 2015 年 12 月 31 日期间新诊断为 MM（n=212）、FL（n=168）、DLBCL（n=195）和 HL（n=233）的≤50 岁患者均被纳入研究。通过标准化死亡率比（SMR）总结观察到的与预期的生存情况。与美国背景人群相比，所有四种癌症在诊断时均存在过度死亡风险，MM 的 SMR 为 19.5（15.2-24.5），FL 为 4.2（2.3-7.2），DLBCL 为 13.0（9.2-18.4），HL 为 5.2（2.6-9.3）。我们推断，治愈最有可能发生在诊断后的前 3 年，并且体现在与背景人群相似的总体生存概率上。从 36 个月的时间点开始，MM（SMR 20.7 [14.7-28.3]）和 FL（SMR 3.8 [1.5-7.8]）出现了过度死亡风险，但 DLBCL（SMR 3.1 [0.8-8.0]）和 HL（SMR 0.9 [0.0-5.1]）没有。与背景人群相比，MM 患者在诊断时和诊断后 3 年的死亡风险高出 20 倍，这表明 MM 仍然是一种无法治愈的癌症。
